Individual provider Active NPI

Diane Tom

  • Peer Specialist
  • Garden Grove, CA
National Provider Identifier
1275101768
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Practice address
12912 Brookhurst St Ste 480
Garden Grove, CA 92840-4867
Phone
(714) 636-6286
NPI assigned
Jun 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X CA
Peer Specialist 175T00000X Primary

Addresses

Primary practice location

12912 Brookhurst St Ste 480
Garden Grove, CA 92840-4867

Mailing address

12912 Brookhurst St Ste 480
Garden Grove, CA 92840-4867
Phone (714) 636-6286

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orange County Asian and Pacific Islander Community Alliance, Inc. CurrentSince Jul 9, 2023 Accepting new patients
South Coast Children'S Society, Inc. PastSince Oct 1, 2024 Accepting new patients

Locations

12912 Brookhurst St
Ste 480
Garden Grove, CA 92840
Phone (714) 636-6286

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1275101768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12912 BROOKHURST ST STE 480",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404867",
            "telephone_number": "714-636-6286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12912 BROOKHURST ST STE 480",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404867",
            "telephone_number": "714-636-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOM",
        "first_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-11",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.